Opioids

Pain care and opioid-use disorder are focus of new efforts

Pain is a tremendous burden on the American public, especially chronic pain, which affects about 100 million Americans, according to a 2011 Institute of Medicine report. With such a high burden on the American public, the AMA House of Delegates (HOD) took actions aimed at improving pain care while expanding access to buprenorphine for patients with opioid-use disorder and encouraging the safe storage and disposal of controlled substances.

A resolution presented by the American Academy of Pain Medicine argued that “an imbalance remains regarding the attention paid by governmental and regulatory agencies toward the appropriate treatment of chronic pain in light of the risks of opioid addiction” and that “ample evidence-based research shows the success of a multidisciplinary pain management program in treating chronic pain, which does not rely heavily on opioids.”

To ensure that pain care gets the attention it deserves amid the vital effort to address the opioid epidemic, delegates directed the AMA to convene a task force from organized medicine to:

  • Discuss medicine’s response to the public health crisis of undertreated and mistreated pain
  • Explore and make recommendations for augmenting medical education designed to educate healthcare providers on how to help patients suffering from pain with evidence-based treatment options
  • Discuss strategies that may prevent or mitigate acute pain, educate physicians about these strategies, and suggest research to study if these strategies prevent the development of chronic pain

Delegates agreed that the task force should include primary care, surgical and other medical specialties that are involved in providing pain care.

In separate actions, delegates asked the AMA Opioid Task Force to continue its work to reduce opioid-related harm by:

  • Continuing to educate all prescribers on the importance of optimal use of opioids” including appropriately limiting the quantities of opioid prescriptions and advocating electronic prescription capabilities for controlled substances.
  • Publicizing existing resources that provide advice on overcoming barriers and implementing solutions for prescribing buprenorphine for treatment of opioid-use disorder.
  • Continuing to adapt current educational materials to distribute to prescribers and patients emphasizing the importance of safe storage and disposal of opioids.
  • Encouraging prescribers to work with local organizations and pharmacists to develop and disseminate the most up-to-date information on local drug take-back events while working with patients to seek more such programs.

Support for harm-reduction pilot

In an action aimed at reducing the harms associated with illicit drug use, the HOD voted to support pilot supervised injection facilities. Such facilities can cut the number of overdose deaths, lower infectious-disease transmission rates and increase the number of people who seek treatment for substance-use disorders, according to research conducted outside the U.S.

“State and local governments around the nation are currently involved in exploratory efforts to create supervised injection facilities to help reduce public health and societal impacts of illegal drug use,” Patrice A. Harris, MD, said in a statement. She is chair of the AMA Board of Trustees and also chairs the AMA Opioid Task Force.

“Pilot facilities will help inform U.S. policymakers on the feasibility, effectiveness and legal aspects of supervised injection facilities in reducing harms and health care costs associated with injection drug use,” Dr. Harris said.

In its deliberations, the HOD relied greatly on the Massachusetts Medical Society, which in April released a comprehensive report on the medical literature related to supervised injection facilities.

Read more news coverage from the 2017 AMA Annual Meeting.